NPI | 1497249783 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 1223G0001X Dentist General Practice (Licence: TN 11189) |
Additional Taxonomies | 1223G0001X Dentist General Practice (Licence: TX 34249) |
Enumeration Date | 2018-06-19 |
Last Update Date | 2021-04-06 |